Heart Problems & Blood Transfusions | Heart Health Program

Blood Transfusions May Have Killed Millions

Last October, I wrote a blog entry about the dangers associated with blood transfusions. It was triggered by a study out of Duke University that found that transfusions increase your risk of heart attack and death. According to the study, the problem is that the oxygen-transporting efficacy of stored blood begins to decay almost immediately. This is because stored red blood cells become deficient in nitric oxide, thus limiting their ability to get oxygen to tissues that need it. Nitric oxide opens up blood vessels, which allows oxygen carrying blood to reach the tissues served by those vessels. In vitro studies show that levels of S-nitrohemoglobin (the molecule that carries nitric oxide in the blood) decline rapidly in stored red blood cells. There is a 70% drop in the first day of storage. By the twenty-first day, the molecule was below the level of detectability. In the U.S., red blood cells can legally be stored up to 42 days before blood banks are required to discard them. But the problem is even worse than it sounds. Not only is transfused blood deficient in nitric oxide, but because it's deficient, it actually sucks nitric oxide out of the surrounding tissue to compensate. This causes that tissue to constrict and become deoxygenated. If that tissue happens to be heart muscle, you have a real problem.

Well, the issue is back in the news, thanks to a couple of new studies.

Transfusions increase the risk of complications and reduce survival rates

The first study, which appears in the March 20th issue of the New England Journal of Medicine, essentially confirms the Duke study. It reports that heart surgery patients who receive transfusions with blood that has been stored more than 14 days are far likelier to suffer complications and may face significantly reduced survival rates -- both short and long term. The study of more than 9,000 patients in the US has shown that those given blood more than 14 days old are 65 percent more likely to die before discharge and 50 percent more likely to die within a year. Recipients of older blood are also at much higher risk of blood poisoning and multi-organ failure according to the survey conducted at the Cleveland Clinic in Ohio. Considering that nearly half of heart surgery patients receive transplants and that the FDA allows blood to be stored for up to 42 days before it must be discarded, this news carries major implications for any heart surgery patients...and their doctors. In point of fact, transfused blood usually takes several days to even reach a hospital. That means that the average patient getting a transfusion is quite likely receiving blood that is pushing two weeks old -- with a sizeable number (60% of O RH negative, for example) receiving blood that is up to four weeks old.

In their study, the Cleveland Clinic researchers examined data on 6,002 patients who had received blood transfusions while undergoing bypass grafting and/or heart-valve surgery between June 30, 1998 and January 30, 2006. Of the patients, 2,872 received 8,802 units of blood that had been stored 14 days or less, whereas 3,130 patients received 10,782 units of blood that had been stored longer than 14 days. The results were disturbing.

in-hospital death (2.8% vs. 1.7%, P=0.004)

prolonged intubation (9.7% vs. 5.6%, P<0.001)

kidney failure (2.7% vs. 1.6%, P=0.003)

sepsis (4.0% vs. 2.8%, P=0.01)

But it gets worse!

Transfusions increase the risk of stroke

A second study, published in November and conducted by scientists at the University of Bristol and the Bristol Heart Institute in the UK, found that patients who received a red blood cell transfusion experienced a three-fold increase in complications arising from lack of oxygen to key organs -- complications such as heart attack or stroke. The study looked at the association between red blood cell transfusion and adverse outcomes in over 8,500 cardiac surgery patients over eight years. The age of the blood used in the transfusions was not a factor in this study. Nevertheless, the study found that the risks associated with transfusions of blood of all ages occurred regardless of the hemoglobin levels in the blood, age, or level of patient disability at the time of transfusion.

Professor Peter Weissberg, Medical Director of the Bristol Heart Foundation said, "Red blood cells carry oxygen around the body to supply vital organs. Not unreasonably therefore, heart surgeons have assumed that patients who have low red blood cell counts after surgery -- as a result of blood loss during or shortly after surgery -- would benefit from a 'top up' transfusion of donated red blood cells. This study shows the importance of putting such widespread beliefs to the test since it suggests that such transfusions may cause more problems than they solve."

As in the US, over half of all heart surgery patients in the United Kingdom receive blood. However, only about 3% of these transfusions are given because of life-threatening bleeding.The vast majority are given on the basis of low hemoglobin levels, regardless of whether the patient has any physical symptoms indicating that they actually need blood -- sort of a better safe than sorry precautionary procedure. But based on the recent study results, it looks like it may not be so safe, and might, in fact, provide a whole lot of reasons to be sorry.

Rethinking transfusions except in dire emergencies

The bottom line is that red blood cell transfusions in patients having cardiac surgery is strongly associated with both infection and ischemic postoperative morbidity, hospital stay, increased early and late mortality, and hospital costs. And significantly, the majority of those transfusions, the ones used on a precautionary basis, may in fact have been responsible for many millions of patient deaths over the last hundred years.

Fortunately, there appears to be a simple remedy for at least one aspect of the problem -- not the infection risks, but the inability of transfused blood to carry sufficient oxygen. Doctors and hospitals just need to implement it. Studies have shown that treating red blood cells with a solution of aqueous nitric oxide results in a 10-fold increase in S-nitrohemoglobin (again, the molecule that carries nitric oxide in the blood) compared with untreated samples so that the levels of S-nitrohemoglobin are not significantly different from fresh blood. As we discussed earlier, this is crucial because stored red blood cells quickly become deficient in nitric oxide, which limits their ability to get oxygen to tissues that need it. Adding nitric oxide to stored blood restores the ability of hemoglobin to dilate blood vessels and oxygenate tissue. In other words, it helps restore the oxygenating power of blood. If you ever need a transfusion, you might want to ask your doctor if the hospital treats their banked blood this way before using it for transfusion. (Unfortunately, there aren't many at the moment.)

Sea water transfusions

When I wrote my blog entry on blood transfusions, several readers wrote in asking about the viability of using sea water transfusions instead of blood transfusions. And in fact, that can work -- sort of.

During World War I, the French Army used a specially filtered and sterilized form of sea water for blood transfusions when blood supplies ran out. And it works if done correctly! The problem is that although such sea water can be used in an emergency to keep blood volume up and maintain proper electrolyte levels for the functioning of the heart muscle, it does not provide the oxygen/carbon dioxide/nitric oxide carrying capabilities of blood since it contains no hemoglobin. It can help in an emergency, but it does not replace blood.

Conclusion: Clinical evidence vs anecdotal evidence

But all that said, that's not my main reason for discussing this issue in today's newsletter. As I said in my heart health blog on the issue, think about it for a moment! Blood transfusions have been used as a standard medical procedure for over 100 years. And now it turns out they may be responsible for many millions of unnecessary deaths worldwide during that time. How could this be? Unlike alternative health, modern medicine is based on science -- not anecdotal evidence. So why didn't all those scientific studies on blood transfusions figure out that blood transfusions are, at best, an iffy proposition that should be reserved only for the most dire of emergencies?

The answer is quite simple. Until recently, there were no studies either supporting or negating blood transfusions -- or at least none that the medical community paid attention to. As I have frequently pointed out, most medical procedures and drug usage are not backed by studies -- only by anecdotal evidence. The lack of clear evidence supporting blood transfusions as a medical procedure is not the exception; it is perfectly in line with the rule. According to the US Government's Office of Technology Assessment (Congress of the United States, Office of Technology Assessment: Assessing the efficacy and safety of medical technologies. Washington, DC: US Government Printing Office, 1978), only 10-20% of all medical procedures and off-label drug usage is backed by clinical studies.

Is that a bad thing? Not necessarily. Things would grind to a standstill if doctors had to wait for definitive studies before implementing any new procedure that seemed to offer benefit. And yes, a key point was missed in the blood transfusion issue for the last hundred years that has probably killed many millions of people during that time. But make no mistake; this is not an indictment of anecdotal evidence. Strong anecdotal evidence among informed professionals is actually quite reliable -- at least as reliable as clinical testing. Just think of how many clinical tests come to diametrically opposed conclusions. In fact, the only reason that these clinical studies were conducted on blood transfusions in the first place is because anecdotal evidence suggesting there was a problem in the first place had been building over the years. You could say that the problem was discovered through anecdotal evidence -- and merely confirmed through a peer reviewed study.

No, the problem isn't with the use of anecdotal evidence. It's with the double standard applied by the establishment (medical and regulatory) that holds complementary medicine to an absurdly higher standard, allowing medical doctors to do pretty much whatever they want. If informed anecdotal evidence is allowable for 85% of all medical procedure and drug usage, why is alternative health held to an impossible 0% standard -- particularly since it doesn't kill anywhere near as many people as modern medicine does? (Remember, we're talking about potentially millions of deaths from transfusions alone.) And we're not even talking about a standard as it applies to actually implementing an alternative health procedure or supplement. No, that 0% standard applies to even "talking" about it. I kid you not. Government regulators do not allow alternative health practitioners to even talk about the possible medical benefits of most essential supplements and herbs. As we discussed in a natural health key newsletter last year, government regulators in the US, Canada, and much of Europe don't allow you to even talk about using stevia as a sweetener in food. The FDA has actually seized stevia recipe books. That's insane.

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Comments

Submitted by Salvatore on

April 4, 2011 - 8:02am

I agree that is it is a double standard that the medical profession is allowed to virtually regulate itself and it's members, and apply anecdotal medicine based on opinions. Often, as in the cited case here, the reality proves to be different to the perceived medical wisdom.

However I disagree that this means that the complementary medicine industry should be exempt from requiring a higher standard - I believe that the same high standard should be applied across the board to all medicine, and all medical practitioners, and that they should be regulated by an independent body - preferably professional scientists. And by "independent" I mean that the people doing the regulating have no financial interests in the results of their recommendations - not just a requirement to "declare financial interests" as is currently allowed. It is a parody of medical professionalism that the public have been misinformed by all parties in the debate, to the detriment of their health and wealth. It is still a sad fact that not only doctors, but also alternative medicine practitioners "bury" their mistakes.

I wonder if we would accept the same lax standards in the requirements for evidence in a criminal prosecution (especially if you yourself were the accused) - should we allow people to be sent to prison or executed because an expert opinion is that they are guilty, without any evidence, or even contrary to evidence? No, of course not. Let's not encourage the same lack of credibility, accountability, safety and respect to the patient in need of real help.

The Nitric Oxide study ( the professor got a grant from the firm that is making this treatment ) - stated that treated blood does not soak up nitric oxide from surrounding tissues - ( which would further compound the restricting of blood vessels ) which allows what blood there is to reach the cells with oxygen.

What is Misleading is that the transfused ( stored ) blood does Not ITSELF carry well Nor release oxygen for 24 to 48 hours - the oxygen is carried by person's old blood already in his veins - all the treated blood does is stop the vessels from closing off - hence not restricting the flow - volume is what is required - the hemocrit level in a resting patient can be 4 gm/dl or lower - I have personally seen 3.3 in someone who was walking around - slowly. Normal Healthy levels are 11 to 15 gm/dl
I know of people with much lower levels - surviving even without the only oxygen carrying medical fluid- Flurosol -on standby- which they had flown in from Japan.

HBOC-201 is Not a volume expander Nor does it carry oxygen. It just makes your red blood cells work better and body make more of them - 65 gm as a unit equals 1 unit of blood ( 1/2 L )

The mention in article about nitric oxide left out some pertinent points. 1-professor got a grant from the manufacturer of product for nitric oxide for blood. 2- the not closing of blood vessels in treated stored blood only means that your existing blood flow continues. 3-Stored blood-even treated does NOT make oxygen available to cells. Stored transfused blood Does Not carry oxygen for 24 to 48 hour - making it a risky volume expander. 4- There is only one medical fluid that carries oxygen and that is Fluosol (spelling ? ) 5-there are 2 products that increase body production of red blood cell - EPO - an approved synthetic and a newer one - not approved - used at 64? gm for a unit to replace ( instead of ) a unit of blood. saftey of 2nd is iffy. 6-resting patients hemocrit levels can be 4 gm/dl or lower without injuring patients provided volume is kept up. Normal according to WHO is 12 however usually ranges from 11-15 gm/dl in Healthy people.

This article does not even come close to what might be considered a Journalistically ethical article. It should be removed until peer reviewed, and I am certain that after it is peer reviewed, there will not be much left of it that is the same.

Where in the world, except of of his imagination, does he get a "statictic' that says millions of people have died as a direct cause of blood transfusions???!!!??? And he says, going back 100 years. Well, transfusing blood was essentially non-existent 100 years ago. The practice has only been around since WWII. Before that it was only an experimental procedure at best.

This article gives a false impression about blood transfusions, and unfortunately, due to this author's negligence and wrecjlessness, this article has been latched onto by Jehovah's Witnesses as some sort of "proof" that blood transfusions are deadly killers and NEVER appropriate medicine. I have already seen this quote that "millions have died from blood transfusions" several times, on forums and around the internet.

I challoeneg the author to step up and admit his CRIME, of spewing misleading rhetoric and FALSE statistics, less he actually CAUSE the death of some who think this article comes close to the standard of good medicla journalism.

I for one am going to be doing a lot of investigation on who this quack is who wrote this article. I am going to pursue means to rip it down off the internet and throw it where it belongs, in a pile of rubbish. I am also going to ask that this ayuthor apologize to the medical community for his FAKE science.

Dear Jean: Did you actually read the article above, because it surely seems that you did not – or at the very least did not understand a single word of it? Jon’s article does not state that you should never have a transfusion under any circumstances. To say so is to misrepresent the article. Jon is merely saying that transfusions, as currently administered, are much less safe than advertised, but can be made much safer relatively easily simply by infusing the blood with nitric oxide before transfusing it – as demonstrated in the Duke study. Keep in mind, the article is not based on Jon’s personal opinion, but, in fact, reports on three separate medically dominated, peer reviewed studies. As cited in the report, they are:

The numbers cited in Jon’s report actually come from these peer reviewed studies. And if you extrapolate these numbers out on the estimated 14 million units of red blood cells that are administered to about 4.8 million Americans annually, the several million deaths that Jon cites since the beginning of all transfusions over the years is actually very low. And if you factor in transfusions performed all over the world, not just in the US, then the actual number is that many orders of magnitude higher. The bottom line is that if you are looking for an apology for FAKE science, then you will have to contact the peer reviewed journals that published the studies that so seem to offend you. Once again, Jon does not say, “Don’t get a transfusion.” What he says is, “Adding nitric oxide to stored blood restores the ability of hemoglobin to dilate blood vessels and oxygenate tissue. In other words, it helps restore the oxygenating power of blood. If you ever need a transfusion, you might want to ask your doctor if the hospital treats their banked blood this way before using it for transfusion.” And really, wouldn’t the true criminal activity be to lie to people and tell them blood transfusions are perfectly safe and “not” tell people how to improve their odds of surviving a transfusion? Now that you understand where the information came from (three separate, peer reviewed journals, representing some of the most prominent medical establishments in the world), and what the article actually says: that you should ask questions before getting a transfusion -- not, “Don’t get a transfusion” – perhaps you will be able to read it again, and actually see what is there, not what your imagination has convinced you is there. PS: As to your statement, “Well, transfusing blood was essentially non-existent 100 years ago. The practice has only been around since WWII. Before that it was only an experimental procedure at best,” you are once again decidedly incorrect. In fact, the history of blood transfusions is as follows: The first fully documented human blood transfusion was administered by Dr. Jean-Baptiste Denys, eminent physician to King Louis XIV of France, on June 15, 1667. In 1840, at St George's Hospital Medical School in London, Samuel Armstrong Lane, aided by Dr. Blundell, performed the first successful whole blood transfusion to treat hemophilia. George Washington Crile is credited with performing the first surgery using a direct blood transfusion several decades later at the Cleveland Clinic (the same Cleveland Clinic, interestingly, that conducted the study published in the New England Journal of Medicine as cited above). The first blood transfusion using blood that had been stored and cooled (what we’re actually talking about in Jon’s report) was performed on January 1, 1916. Oswald Hope Robertson, a medical researcher and U.S. Army officer, is generally credited with establishing the first blood bank while serving in France during World War I. In other words, Jon’s estimate of 100 years, probably ranks on the conservative side. But at the very least, we’re talking about 95 years since the establishment of the world’s first blood bank. For more information on the history of blood transfusions – you might want to check out: http://blood.ygoy.com/2010/04/14/first-successful-transfusion-of-blood/ Hope that helps.

Read the Chicago Tribune Julu 22 2012 magazine artile on Summer's insect beacon ,I see that the firefly's light is explained thus:
The trachea, carrying oxygen, has as a ring of cells on the outside, immediately after is the first layer (mitochrondia) of a torus of photocytes infused with peroxisomes.
The mitochrondia consume all the oxygen needed by the peroxisomes to light. The firefly's brain releases nitric oxide which disable the mitochrondia allowing the oxygen to pass.
When I read that I thought of this problem with old blood. Isn't that the opposite? Nitric acid is needed to allow the oxygen to be absorbed in humans but in fireflys it is used to disable oxygen uptake. Feel free to correct me as I am not understanding the matter.

I read this article. Please show the numbers suggesting that blood transfusions have, over the last hundred years, probably killed many millions of people.

Procedures of the cited studies were not performed over that period of time for blood transfusion to complicate.

As medical care improves there is opportunity to find and understand complications that did not exist before because patients suffered mortality from a primary condition rather than secondary complications.

I believe there are so many blood alternatives, cell saver machines, blood fractions, saline so many other cheaper cleaner alternative to using blood, its all about the volume. Its been proven that those who have chosen blood alternatives have also recovered faster and there own blood increased in volume much quicker and have much less side affects, its funny but its the red cross who brings out the blood alternative seminars to teach people (who want to know that is), it is also proven that everyone's blood is like a finger print no blood is the same and there for should not be mixed with anyone else's, people just havn't been given the opportunity to learn about it, I have a blood directive written up in case of emergency and will be treated with no blood products, it really works and would save the world a tone of money but hay that's why the government don't really want people to know, its all about greed , anyway that's my option, my grandfather died from a blood transfusion so I guess I did my research and know that you don't need to transfuse, people would be shocked how many people really die of transfusions.

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